Healthcare Provider Details

I. General information

NPI: 1700161460
Provider Name (Legal Business Name): AMBER LEANNE SALDATE-STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 W SHAW AVE STE D1
FRESNO CA
93711-3513
US

IV. Provider business mailing address

1616 W SHAW AVE STE D1
FRESNO CA
93711-3513
US

V. Phone/Fax

Practice location:
  • Phone: 559-801-1480
  • Fax:
Mailing address:
  • Phone: 559-801-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number86041
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: